Anterior cervical plating system

ABSTRACT

An anterior cervical plating system for securing multiple bone segments relative to each other includes a plate member having multiple pairs of nodes. Each node defines a bone screw aperture. Linking segments connect the pairs of nodes to one another. Between adjacent linking segments are elongated viewing windows. The bone screw apertures each include an integral locking mechanism to ensure that the bone screws do not back out of the plate member. The locking mechanisms and the bone screw apertures allow for angular freedom of insertion of the bone screws into a vertebral body or other bone portion.

FIELD OF THE INVENTION

[0001] The present invention relates generally to orthopedic surgicalprocedures, most particularly for use in fixation of the spine. Moreparticularly, the present invention relates to a system for anteriorlyfixating the cervical spine. The present invention also pertains to arelated method of withdrawing a bone screw from a plate.

BACKGROUND OF THE INVENTION

[0002] In certain orthopedic surgical procedures, it is necessary tosecure multiple bones or bone portions relative to each other. Forexample, in spinal surgeries, the fusion of two or more vertebrae bodiesis required to secure a portion of the spinal column in a desiredposition. This need may be the result of physical trauma from fracturesor dislocations, degenerative diseases, or tumors.

[0003] One such spinal fixation procedure involves the attachment of aprosthesis or plate to the anterior side of the cervical portion of thespine. The procedure requires anteriorly accessing the spine andsecuring a prosthetic plate to the one or more cervical vertebrae. Thisallows fusion of the one or more cervical vertebrae in a particularorientation so to facilitate healing or to repair a condition of thepatient.

[0004] Various fusion plates and plating systems are known foranteriorly fusing the cervical spine. While known anterior platingsystems have addressed certain requirements associated with the surgicalrepair of bone, in general, and spinal fusion, particularly, all areassociated with limitations. The requirements associated with spinalstability and system reliability over an extended period of use oftenconflict with the requirements of an easy to use implant. For example,strength requirements for a fusion plate tend to make the plate bulkyand adversely effect intra-operative and post-operative viewing of theassociate area of the spine. In this regard, the affected region of thecervical spine cannot be easily viewed using MRI or x-ray procedures toverify that the desired fusion of the cervical spine is complete and/orthat the alignment of the cervical vertebrae is proper.

[0005] Additionally, ensuring that bone screws do not loosen over timeor back out from the plate tends to complicate implantation of knownanterior plating systems. Known locking mechanisms generally ensure thatthe bone screws placed into the vertebrae through the plating system donot loosen or back out from the plate. When a locking mechanism has beenincluded with known anterior cervical plating systems, it generallyincorporates a discrete fastener or other element. As such, anadditional surgical step is required. Furthermore, known lockingmechanisms do not adequately permit the removal of an associated bonescrew when required.

[0006] Furthermore, known plating systems often do not permit sufficientangular freedom for bone screws relative to a plate. Generally, knownplating systems have defined bores through which bone screws are placedat a predefined angle. Therefore, the operating surgeon often does nothave freedom to insert the bone screws into the vertebrae as to best fitthe anatomy of the individual patient. While some known systems dopermit bone screw angulation, they typically are not adapted to be usedwith an easy to use locking mechanism.

[0007] It remains desirable in the pertinent art to provide an anteriorcervical plating system that addresses the limitations associated withknown systems, including but not limited to those limitations discussedabove.

SUMMARY OF THE INVENTION

[0008] The present invention relates to plating systems for the fixationof the cervical spine. In particular, the present invention relates toan anteriorly placed plating system for a cervical portion of the spine.According to one aspect, the present invention relates to a lockingmechanism for preventing the withdrawal of locking bone screws from aplate after being implanted. The locking mechanism is integral to theplating system and does not require the additional insertion ofadditional fasteners or other discrete members into the plate after thebone screws have been fastened to the spine. The locking mechanismpreferably allows for angular freedom of the bone screws as they areinserted through the plate.

[0009] In another aspect, the present invention relates to a platemember of a cervical plating system that permits enhanced viewing of anadjacent portion of the spine area intra-operatively andpost-operatively the plate member includes a first pair of nodes havinga first node and a second node defining first and second bone screwapertures, respectively. The first and second nodes are at leastpartially circular in shape and spaced apart from one another in a firstdirection. The plate member additionally includes a second pair of nodeshaving a third node and a fourth node defining third and fourth bonescrew apertures, respectively. The third and fourth nodes are at leastpartially circular in shape and spaced apart from one another in thefirst direction. The plate member further includes a first plurality oflinking segments extending in a second direction substantiallyperpendicular to the first direction and connecting the first and secondpairs of nodes. Adjacent linking segments define elongated viewingwindows.

[0010] In a further aspect, the present invention relates to a method ofsurgically repairing bone with an elongated plate having a plurality ofbone screw apertures. The method includes the step of locating a lockingring in one of the bone screw apertures. The locking ring defines alocking ring opening and is resiliently expandable from a retractedstate to an expanded state such that the locking ring opening has afirst opening diameter in the retracted state and a second, largerdiameter in the expanded state. The method additionally includes thestep of removing the bone screw from the one bone screw aperture with atool having a first portion engaging the head of the bone screw and asecond portion resiliently expanding the locking ring to the expandedstate.

[0011] In yet another aspect, the present invention relates to a systemfor surgically repairing bone. The system includes an elongated platehaving a plurality of bone screw apertures. A locking ring is disposedin one of the bone screw apertures. The locking ring defines a lockingring opening and is resiliently expandable from a retracted state to anexpanded state such that the locking ring opening has a first openingdiameter in the retracted state and a second, larger diameter in theexpanded state. A bone screw is inserted into the one of the bone screwapertures. The bone screw has a head with a diameter greater than thefirst opening diameter and less than the second opening diameter. Thesystem further includes a tool for removing the bone screw from the onebone screw aperture. The tool has a first portion engaging the head ofthe bone screw and a second portion for resiliently expanding thelocking ring to the expanded state.

[0012] An advantage of the present invention is to provide an anteriorcervical plating system that provides a locking mechanism including apre-attached locking ring, thereby eliminating the need for discretelocking components.

[0013] Another advantage of the present invention is to provide ananterior cervical plating system with an integral locking mechanism thatmaintains a low profile and thereby minimizes interferences withanatomical soft tissue structure.

[0014] Another advantage of the present invention is to provide ananterior cervical plating system that provides a plate having an opendesign permitting intra-operative visualization of bone grafts andvertebrae end plates, as well as post-operative visualization of bonegraft consolidation and spinal orientation on an anterior/posteriorx-ray.

[0015] Another advantage of the present invention is to provide ananterior cervical plating system that provides a variable angle bonescrew permitting approximately 20° of screw angulation.

[0016] Another advantage of the present invention is to provide acervical plating system including a predefined angle. Therefore, theplate need not be manually fashioned to fit the spine thereby decreasingsurgical time and interference with soft tissue after implantation.

[0017] Additional advantages and further areas of applicability of thepresent invention will become apparent from the following detaileddescription and appended claims. It should be understood that thedetailed description and specific examples, while indicating thepreferred embodiment of the invention, are intended for purposes ofillustration only and are not intended to limit the scope of theinvention.

BRIEF DESCRIPTION OF THE DRAWINGS

[0018] The present invention will become more fully understood from thedetailed description and the accompanying drawings, wherein:

[0019]FIG. 1 is a perspective view of an anterior cervical platingsystem according to the teachings of a preferred embodiment of thepresent invention, the system illustrated to include a first platemember.

[0020]FIG. 2 is a top view of the first plate member of the anteriorcervical plating system according to the present invention.

[0021]FIG. 3 is an end view of the first plate member of the anteriorcervical plating system according to the present invention.

[0022]FIG. 4 is a cross-sectional end view of the plating systemaccording to the teachings of a preferred embodiment of the presentinvention.

[0023]FIG. 5 is a top view of a second plate member of the anteriorcervical plating system according to the present invention.

[0024]FIG. 6 is a perspective view of a third plate member of theanterior cervical plating system according the present invention, thethird plate member shown secured to a cervical portion of a spine andfurther shown operatively associated with a tool for inserting andremoving the bone screws.

[0025]FIG. 7 is an enlarged side view of the tool shown in FIG. 6.

[0026]FIG. 8 is an enlarged view illustrating the details shown incircle 8 identified in FIG. 7.

[0027]FIG. 9 is an enlarged end view of the tool taken in the directionof arrow 9 shown in FIG. 8.

[0028]FIG. 10 is a cross-sectional view illustrating engagement of thetool with one of the bone screws shown operatively associated with alocking ring.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

[0029] The following description of the preferred embodiment of thepresent invention will be understood to be merely exemplary in natureand in no way is intended to limit the subject invention, itsapplication, or uses.

[0030] With initial reference to FIG. 1, a plating system according tothe teachings of a preferred embodiment of the present invention isillustrated and generally identified at reference number 10. Theembodiment illustrated is specifically intended for use as an anteriorcervical plating system. However, it will become apparent to thoseskilled in the art below that the teachings of the present invention aresuitable for other applications in which surgical repair of bone with aplate is desired.

[0031] With continued reference to FIG. 1 and additional reference toFIGS. 2-4, the anterior plating system 10 according to the preferredembodiment of the present invention is shown to generally include afirst plate member 12. The first plate member 12 is intended to addressone disk level and attach to two adjacent vertebrae. The anteriorplating system 10 is further shown to generally include a plurality ofbone screws or fasteners 14 and a plurality of locking mechanisms 16 forpreventing the bone screws 14 from backing out of the plate member 12 orloosening with respect to a vertebral body 18 (shown in FIG. 6) or otherbone portion.

[0032] The plate member 12 includes a first pair of nodes having a firstnode 20 and a second node 22. The first and second nodes 20 and 22define first and second bone screw apertures 24 and 26, respectively.The first and second nodes 20 and 22 are generally cylindrical in shapeand are laterally spaced apart from one another in a first direction. Inthe embodiment illustrated and in a manner to be more fully discussedbelow, the first and second bone screw apertures 24 and 26 are intendedto receive a pair of fasteners 14 for engaging a first vertebral body18.

[0033] In a similar manner, the plate member 12 includes a second pairof nodes having a third node 28 and a fourth node 30. The third andfourth nodes 28 and 30 define third and fourth screw apertures 32 and34, respectively. Again, the third and fourth nodes 28 and 30 aregenerally cylindrical in shape and spaced apart from one another in alateral direction. The third and fourth bone screw apertures 32 and 34are intended to receive a pair of fasteners 14 for engaging a secondvertebral body 18.

[0034] The plate member 12 is further shown to include a plurality ofaxial bridges or linking segments 36 which connect the first and secondpairs of nodes. The linking segments of the first plurality of linkingsegments 36 extend in a longitudinal or axial direction which isessentially perpendicular to the lateral direction in which the nodes ofthe pairs of nodes are spaced apart. The first plurality of linkingsegments 36 define elongated viewing windows. Explaining further, theelongated viewing windows 38 contribute to an open design of the platemember 12 that permits intra-operative visualization of bone grafts andvertebrae end bodies, as well as post-operative visualization of bonegraft consolidation and spinal orientation on an anterior/posteriorx-ray.

[0035] In the embodiment illustrated, the plate member 12 is illustratedto include three (3) linking segments 36. As such, adjacent linkingsegments 36 define two (2) elongated viewing windows 38. Those skilledin the art will readily appreciate that the particular number of linkingsegments 36 and elongated viewing windows 38 may be altered within thescope of the present invention.

[0036] As particularly shown in the end view of FIG. 3 and thecross-sectional view of FIG. 4, the plate member 12 is contoured about alongitudinally extending midline 40 (shown in FIG. 2). In this regard,the plate member 12 is shown to include a first lateral half oriented atan obtuse angle relative to a second lateral half. In one application,the obtuse angle is between approximately 160° and 170°. The contour ofthe plate member eliminates manual fashioning of the plate member 12 tofit the contour of the spine, thereby decreasing surgical time. Thecontour of the plate member 12 also decreases interference with adjacentsoft tissue after implantation.

[0037] With reference to FIG. 5, a second plate member 42 of theanterior cervical plating system 10 of the present invention isillustrated. The second plate member 42 shares various features with thefirst plate member 12. For this reason, like reference numerals havebeen used to identify substantially identical elements between the firstand second plate members 12 and 42. The second plate member 42 differsfrom the first plate member 12 in that the linking segments 36 arelonger and the viewing windows 38 are correspondingly longer. The secondplate member 42 is intended to illustrate the flexibility of the presentinvention to accommodate patients having variable spinal dimensions. Itwill be understood that the length of the linking segments 36 may belonger or shorter than the linking segments 36 of plate members 12 and42.

[0038] With reference to FIG. 6, a third plate member 46 of the anteriorcervical plating system 10 of the present invention is illustrated. Thethird plate member or two disk level plate member 46 is intended toaddress two disk levels by attachment to three adjacent vertebrae. Thethird plate member 46 is similar to the second plate member 42 andadditionally incorporates a third pair of nodes. The third pair of nodeshas fifth and sixth nodes 48 and 50 defining fifth and sixth bone screwapertures (not specifically shown). As discussed with respect to thenodes described above, the fifth and sixth nodes 48 and 50 are generallycylindrical in shape and spaced apart from one another in the lateraldirection. The bone screw apertures of the fifth and sixth nodes 48 and50 receive bone screws 14 for engaging a third vertebral body 18 orother bone portion.

[0039] The third pair of nodes is connected to the second pair of nodesthrough a second plurality of linking segments 52. The second pluralityof linking segments extend in the axial or longitudinal direction.Again, adjacent linking segments 52 of the second plurality of linkingsegments define elongated viewing windows 54.

[0040] The bone screws 14 of the system 10 of the present invention willbe understood to be identical. As will become apparent below, in theexemplary embodiment the bone screws 14 cooperate with the plate member12 to provide a range of angular freedom of the bone screws 14 relativeto the plate 12. Alternatively, the bone screws 14 and apertures of theplate member 12 can be constructed in a known manner to restrict orprevent such angular freedom. In the embodiment illustrated, the bonescrews 14 are permitted to articulate universally relative to the platemember 12 through a range of approximately 20°. Such relativearticulation allows for operative freedom in obtaining purchase of thebone screw in the vertebral bodies 18. As shown most clearly in thecross-sectional view of FIG. 4, the bone screws 14 adjacent to oneanother about the longitudinally extending center line 40 of the platemember 12 preferably converge as they extend into the vertebral body 18.

[0041] Each of the bone screws 14 is illustrated to include a headportion 58, a neck portion 59 and a shaft portion 60. The head portion58 is shown to include a partially spherical segment 62 that engages aninwardly tapering lower portion 64 of the bone screw aperture 24, forexample. These cooperating surfaces 62 and 64 facilitate relativemovement between the bone screw 14 and associated one of the aperturesof the plate member 12. The diameter of the head portion 58 of the bonescrew 14 is larger than the opening of the bone screw aperture at alower surface 66 of the plate member 12, thereby preventing the bonescrew 14 from passing completely through the bone screw aperture.

[0042] The shaft 60 is shown to have a tapered shape with a relativelyhigh pitch thread 68. The specific shaft features such as thread pitch,shaft diameter, and the like, are a matter of design choice and surgicalpreference.

[0043] In the exemplary embodiment illustrated, a locking mechanism inthe form of a locking ring 16 is disposed within each of the bone screwapertures. The locking rings are illustrated as split locking rings 16and are retained within the bone screw apertures. As such, discretefasteners or other locking mechanisms are eliminated.

[0044] Each of the locking rings 16 is shown to include a first or lowerradially extending flange 70 and a second or upper radially extendingflange 72. The first radially extending flange 70 defines a loweropening 74 and the second radially extending flange 72 defines an upperopening 76. The first radially extending flange 70 is retained within anannular groove 80 formed in the sidewall of each of the bone screwapertures. The first and second radially extending flanges 70 and 72 areconnected by an intermediate segment 82 such that the second radiallyextending flange is positioned slightly above an upper surface 84 of theplate member 12.

[0045] Each of the locking rings 16 is constructed of a suitable metaland is resiliently expandable from a retracted state to an expandedstate. The retracted state is shown in FIGS. 1-4. The expanded state isshown in FIG. 10. When the locking ring 16 is in its retracted state,the opening 76 of the second radially extending flange 72 has a firstdiameter that is smaller than the diameter of the head portion 58. Whenthe locking ring is in the expanded state, the diameter of the opening76 is slightly greater than the diameter of the head portion 58 tothereby allow the head portion 58 to pass through the opening 76.

[0046] The bone screws 14 can be inserted with a conventional tool (notshown) having a philips-type head. When the bone screws 14 engage avertebral body 18 and through rotation are drawn downward, the sphericalsegment 62 of the head portion 58 resiliently expands the locking member16 from the retracted state to the expanded state. After the headportion 58 passes completely through the opening 76, the locking ring 16resiliently returns to its retracted state and provides an audiblyperceivable click. In this manner, the bone screws 14 are prevented frombacking out relative to the plate member 12 and from loosening theirpurchase within the vertebral bodies 18. The particular configuration ofthe locking member 16 effectively prevents backing out of the bonescrews 14. In this regard, if a bone screw 14 begins to back out, thehead 58 of the bone screw 14 will engage a conically tapered innersurface of the locking ring 16. Such engagement forces the firstradially extending flange 70 radially outward into the groove 80.

[0047] Turning now to FIGS. 6-10, a tool 90 for removing the bone screws14 is illustrated. The tool 90 may also be used to insert the bonescrews 14. However, the conventional philips-type screwdriver mayprovide the surgeon with better visibility of the head 58.

[0048] The tool 90 is illustrated to include a handle portion 92 havingan upper portion or knob 94, a lower portion 96, and an intermediateportion 97. The upper portion 94 is adapted to rotate with a firstportion or first drive portion 98, while the lower portion 96 is adaptedto rotate with a second portion or second drive portion 100.

[0049] The intermediate portion 98 translates the first drive portion 97relative to the second drive portion 100. The first drive portion 98 isillustrated as an externally threaded shaft and is adapted to engage aninternally threaded aperture 102 of the head portion 58 of each of thebone screws 14. The second drive portion 100 comprises a hollowcylindrical member surrounding the first portion 98 and includes a tiphaving four drive elements 104 equally spaced about the first drivemember 98. The drive elements 104 are adapted to engage a correspondingnumber of slots 106 (shown in FIG. 1) equally spaced about the headportion 58 of each of the bone screws 14. The drive elements 104 includeouter surfaces lying on a circle having a diameter substantially equalto the diameter of the opening 76 when the locking ring 16 is in theexpanded state. The diameter of the circle is slightly greater than thediameter of the head portion 58.

[0050] When the bone screws 14 are implanted into the vertebral bodies18 (in the orientation shown in FIG. 4, for example), the tool 90 can beused to retract the bone screws 14. The first portion 98 threadablyengages the internally threaded aperture 102 of the head portion 58through rotation of the upper portion 94 of the handle 92 in a clockwisedirection. Rotation of the intermediate portion 97 of the handle 92draws the tool 90 down onto the implanted bone screw 14. As the secondportion 100 is drawn downward, the drive elements 104 resiliently expandthe locking member 16 from its retracted state to its expanded state andthe drive elements 104 engage the slots 106 of the head portion 58. Oncethe locking ring 16 expands, the lower portion 96 of the handle 92 canbe rotated to correspondingly rotate the second drive portion 100 andback the bone screw 14 out of the associated bone screw aperture.

[0051] In one application, the preferred material of the plate and thebone screws of the present invention is a titanium alloy. One suitablealloy is Ti-6Al-4V. However, it will be understood that the preferredmaterial is not the only material form which the components of thepresently disclosed invention may be formed. In this regard, the plateand bone screws may be constructed of any suitable biocompatiblematerial which has the structural strength and durability to withstandthe cyclical loading associated with long term fixation.

[0052] While the invention has been described in the specification andillustrated in the drawings with reference to a preferred embodiment, itwill be understood by those skilled in the art that various changes maybe made and equivalents may be substituted for elements thereof withoutdeparting from the scope of the invention as defined in the claims. Inaddition, many modifications may be made to adapt a particular situationor material to the teachings of the invention without departing from theessential scope thereof. For example, additional pairs of nodes may beincorporated for addressing additional disk levels. Therefore, it isintended that the invention not be limited to the particular embodimentillustrated by the drawings and described in the specification as thebest mode presently contemplated for carrying out this invention, butthat the invention will include any embodiments falling within thedescription of the appended claims.

What is claimed:
 1. A plate member for an anterior cervical platingsystem, the plate member comprising: a first pair of nodes having afirst node and a second node defining first and second bone screwapertures, respectively, the first and second nodes both being at leastpartially circular in shape and spaced apart from one another in a firstdirection; a second pair of nodes having a third node and a fourth nodedefining third and fourth bone screw apertures, respectively, the thirdand fourth nodes both being at least partially circular in shape andspaced apart from one another in the first direction; a first pluralityof linking segments extending in a second direction substantiallyperpendicular to the first direction and connecting the first and secondpairs of nodes, adjacent linking segments defining elongated viewingwindows.
 2. The plate member for an anterior cervical plating system ofclaim 1, wherein the plurality of linking segments includes at leastthree linking segments.
 3. The plate member for an anterior cervicalplating system of claim 1, further comprising a third pair of nodeshaving a fifth node and a sixth node defining fifth and sixth bone screwapertures, respectively, the fifth and sixth nodes both being at leastpartially circular in shape and spaced apart from one another in thefirst direction; and a second plurality of linking segments extending inthe second direction and connecting the second and third pairs of nodes,adjacent linking segments of the second plurality of linking segmentsdefining elongated viewing windows.
 4. The plate member for an anteriorcervical plating system of claim 1, wherein the plate member iscontoured about a longitudinally extending midline to include a firstlateral half oriented at an obtuse angle relative to a second lateralhalf.
 5. A plating system for securing a first portion of bone to asecond portion of bone, the plating system comprising: a plate memberdefining a plurality of bone screw apertures, at least one of theplurality of bone screw apertures including an annular groove formed ina sidewall portion; a plurality of bone screws each inserted into anassociated bone screw aperture of the plurality of bone screw apertures;and a locking ring retained in at least one of the plurality of bonescrew apertures and operative to prevent backing out of the bone screwinserted in the at least one bone screw aperture, the locking ringincluding a first radially extending flange disposed in the annulargroove of the at least one bone screw aperture and a second radiallyextending flange upwardly spaced from the first radially extendingflange.
 6. The plating system for securing a first portion of bone to asecond portion of bone of claim 5, wherein the locking ring isresiliently expandable from a retracted state to an expanded state topermit insertion of one of the bone screws into the at least one bonescrew aperture.
 7. The plating system for securing a first portion ofbone to a second portion of bone of claim 6, wherein each bone screw ofthe plurality of bone screws has a head having a head diameter andfurther wherein the second radially extending flange defines an upperopening having a first diameter when the locking ring is in theretracted state and a second diameter when the locking ring is in theexpanded state, the first diameter being less than the head diameter,the second diameter being greater than the head diameter.
 8. The platingsystem for securing a first portion of bone to a second portion of boneof claim 7, wherein the first radially extending flange defines a loweropening having a third diameter when the locking ring is in theretracted state, the third diameter being greater than the headdiameter.
 9. The plating system for securing a first portion of bone toa second portion of bone of claim 5, wherein the plurality of bonescrews and the plurality of bone screw apertures cooperate to permituniversal movement of each of the bone screws relative to the associatedbone screw aperture.
 10. The plating system for securing a first portionof bone to a second portion of bone of claim 5, wherein the locking ringis a split locking ring.
 11. The plating system for securing a firstportion of bone to a second portion of bone of claim 9, wherein a headof each of the bone screws includes a partially spherical portion forarticulably engaging the plate member.
 12. A method of surgicallyrepairing bone with an elongated plate having a plurality of bone screwapertures, the method comprising the steps of: locating a locking ringin one of the bone screw apertures, the locking ring defining a lockingring opening and being resiliently expandable from a retracted state toan expanded state such that the locking ring opening has a first openingdiameter in the retracted state and a second, larger opening diameter inthe expanded state; inserting a bone screw into the one of the bonescrew apertures, the bone screw having a head with a head diametergreater than the first opening diameter and less than the second openingdiameter; and removing the bone screw from the one bone screw aperturewith a tool having a first drive portion engaging the head of the bonescrew and a second drive portion resiliently expanding the locking ringto the expanded state.
 13. The method of securing a first bone portionrelative to a second bone portion of claim 12, further comprising thestep of threadably engaging the head of the at least one bone screw withthe first drive portion of the tool.
 14. The method of securing a firstbone portion relative to a second bone portion of claim 12, furthercomprising the step of rotating the at least one bone screw with thesecond drive portion of the tool.
 15. A system for surgically repairingbone, the system comprising: an elongated plate having a plurality ofbone screw apertures; a locking ring disposed in one of the bone screwapertures, the locking ring defining a locking ring opening and beingresiliently expandable from a retracted state to an expanded state suchthat the locking ring opening has a first opening diameter in theretracted state and a second, larger opening diameter in the expandedstate; a bone screw inserted into the one of the bone screw apertures,the bone screw having a head with a diameter greater than the firstopening diameter and less than the second opening diameter; and a toolfor removing the bone screw from the one bone screw aperture, the toolhaving a first drive portion engaging the head of the bone screw and asecond drive portion for resiliently expanding the locking ring to theexpanded state.
 16. The system for surgically repairing bone of claim15, wherein the first drive portion of the tool threadably engages aninternally threaded aperture provided in the head of the bone screw. 17.The system for surgically repairing bone of claim 15, wherein the seconddrive portion of the tool includes a hollow cylindrical membersurrounding the first drive portion.
 18. The system for surgicallyrepairing bone of claim 17, wherein the second drive portion includes atip having a plurality of drive elements for engaging a correspondingnumber of slots provided in the head of the bone screw.
 19. The systemfor surgically repairing bone of claim 18, wherein the drive elements ofthe plurality of drive elements are radially spaced about the firstdrive portion and include outer surfaces on a circle having a diametersubstantially equal to the second diameter of the locking ring.
 20. Thesystem for surgically repairing bone of claim 15, wherein the firstdrive portion is independently rotatable relative to the second driveportion.